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HomeMy WebLinkAbout11-08-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SITES MARY E 21 SUSQUEHANNA AVE APT 306 ENOLA, PA 17025 -------- fold ESTATE INFORMATION: sSN: ~8s-2s-4353 FILE NUMBER: 211 1-1202 DECEDENT NAME: BATED WAYNE E DATE OF PAYMENT: 1 1 /08/201 1 POSTMARK DATE: 1 1 /07/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 10/ 10/ 201 1 REMARKS: SEAL CHECK#1277 ACN ASSESSMENT CONTROL NUMBER REV-1162 EX(11-96) NO. CD 015187 AMOUNT 11173252 ~ 563.30 TOTAL AMOUNT PAID: 563.30 INITIALS: DMB RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~. PENNSYLVANIA INHERITANCE TAX • INFORMATION NOTICE FILE N0. 21 - ~' - t ZpZ BUREAU OF INDIVIDUAL TAXES AN D Po eox 2so6ol pennsylvar '~~` -' ACN 11173252 HARRISBURG PA 17128-0601 DEPARTMENT Of REVENUE. I T~T"rji~ER RESPONSE DATE 11-U7-2U11 ~~-- ,~! h REV-1543 EX RFP (05-11]'. _,:J TYPE OF ACCOUNT <~ ~ ~.;.J~'1 _a ~' : ~ G`~ST. OF WAYNE E BATES ^ savlNCs SSN 186-28-4353 © CHECKING rL~~,~ (~ DATE OF DEATH 10 - 10 - 2011 ^ TRUST \~ ~, ~ COUNTY CUMBERLAND ^ CERTIF. GRf'N,A,,;'„ CURT Ct~~~~r'~" '~"` r"'^ REMIT PAYMENT AND FORMS T0: MARY E SITES REGISTER OF WILLS APT 306 1 COURTHOUSE SQUARE 21 SUSQUEHANNA AVE CARLISLE PA 17013 ENOLA PA 17025-2442 PN C BANK NA provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If yoU are the SpoUSe of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return -- it tc the above address. Please call 717-787-8327 with puestions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5140316878 Date 05-06-2010 7o ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 8 4 4 . 0 0 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 422.00 months of the decedent's date of death, ~( 15 deduct a 5 percent discount on the tax due. Tax Rate , Any inheritance tax due will become delinquent Potential Tax Due $ 63.30 nine months after the date of death. PART TAXPAYER RESPONSE FAIL ES~ NIi,M~I \1~.5 T eI ~~ CIAt. T AS5ESS~ENT A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or return this notice to the Register of Wills and C H E C K an official assessment will be issued by the PA Department of Revenue. ONE C B L 0 C K B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return 0 N L Y filed by the estate representative. C. ^ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART ~2 and/or PART ~ below. PART If indicating a different tax rate, please state ~, (~ICI~j~ USE,'t~.Y ^,~ ~~ relationship to decedent: PA DEPARTMENT OF REVENUE TAX RE TURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 $ 2 a 2. Account Balance 2 X 3 - --- - 3. Percent Taxable 3 $ 4 4. Amount Subject to Tax 4 - 5 5. Debts and Deductions 5 '~ 6 6. Amount Taxable 6 , 7. Tax Rate 7 X 7 ~~,nm ~.. ,. ~~ .~ 8. Tax Due 8 PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true, correct and omplete to the best of my knowledge and belief. HOME C ) ~ '-~~ ~~~. ~_ W O R K C ) !~,?~ TAXPAYER S NATURE TELEPHONE NUMBER TE TOTAL (Enter on Line 5 of iax Compuia LlonJ a ~~ ~~.~ ~r ~- u '~' r V 0 ~. ~ ', v i;.,f IfA _ I,sl ~rJ n ~.tl 1•.I P . ~I w. ~ X .. r. {V ti Q tom' Vv ~`~- .`... :.. ti -.. w !~ B4. ~"y.~h ~~ ~~ *~ °«{. 'E5 ~i ~~ ~~ ~ #~ ~ n ~~ ~ . 3 ~ , ~s ~~_ •~ ~ r ~~ aan3voe ss ~ v n_